Ten Things to Know About Dissociative Identity Disorder
The DID diagnosis is often missed: It almost always co-exists with other mental conditions, such as depression, anxiety, PTSD, eating disorders, or self-destructive behavior. ~ I didn’t have an official DID diagnosis until seven years into therapy, when it was finally anticlimactic. By that time, my alternate Parts were openly interacting with my therapist. In the meantime, my diagnoses were Anxiety and Complex PTSD.The thing no one tells you about CPTSD, particularly with dissociation, is that flashbacks are not memories. My flashbacks plunged me into feelings and physical symptoms that terrorized me. I felt I was losing my life.
While all trauma does not cause dissociation, all dissociative identity disorders have trauma in their early histories. ~ I did not remember early childhood trauma, but I suffered unrelenting flashbacks. They were painful and full of frightening imagery that hinted at something heartbreaking in my past. I suspected that my core trauma was even more devastating than my menacing flashbacks. Voices from other Parts of me persisted, and because I needed to work safely in my profession as a pediatric critical care RN, I agreed to psychotherapy without knowing where it would lead.
Anyone from any background can have DID, but its defining feature is that it develops unconsciously in childhood to tolerate overwhelming trauma, i.e., physical or sexual abuse. ~ DID is not a choice. When I came to know my alternate Parts, I understood they had saved me. In a genius survival mechanism, my brain created other personalities to hold what I couldn’t possibly bear to know, to keep me safe and ignorant for many decades.
DID is a hidden disorder. The point of dissociating is to remain hidden, to appear “normal.” ~ People are surprised to learn that someone they know well has a dissociative identity disorder, we hide it so well. For a long time, I didn’t know, either. I was managing a complex inner world that no one else could see. By definition, two or more separate identities were present in my psyche at any given time, and long before I accepted that I had five primary alternate Parts, I hid them from myself. I wanted to be normal and I feared I might be crazy, so I did all I could to appear unbroken and whole.
DID used to be known as Multiple Personality Disorder. ~ The Multiple Personality label has contributed excessively to the stigma experienced when one has a DID diagnosis. Actually, rather than multiple personalities, my Parts were more correctly understood as fragmented components of a single personality that had been dissociated from each other.
Most people do not realize they have DID until later in life, when it can be pretty scary figuring out what is going on. ~ One day I was apparently normal, the next my multiple identities appeared, and I was blindsided. It was not unusual that I was midlife, in my fifties, when my explosive DID crisis sent me to psychotherapy, but I had no way of knowing that. I was afraid I was going insane.
Unlike portrayals of DID in film and television, DID does not make me behave violently. ~ Storytellers and film producers picked up on the dramatic value of fictionalizing DID long ago with Robert Lewis Stevenson’s Dr. Jekyll and Mr. Hyde in 1886, through Sybil, the book and the movie in 1976, and numerous others today. Even though a current film, Moon Knight, tries to present the dissociative hero as a troubled man, the movie remains unable to resist the sensationalism that is utterly absent in actual DID. Trauma and pain are at the heart of DID. The portrayal of the dangerous DID villain for entertainment purposes remains ethically inappropriate, misleading, and disrespectful.
DID identity switches are mostly internal, seamless, and invisible. Switching between identities is rarely noticeable or dramatic. ~ When I have questioned the people around me about their observations, they tell me my switches look like “moods.” My family attributed my changes in affect to my “moodiness.” My therapist told me “It didn’t seem unusual to me — just expressive. You could be more integrated, but I doubt many people would even notice. We all appear different when expressing different emotions.”
DID is treatable. ~ I was originally afraid that traumatic changes in my young developing brain and memory would be permanent, that what was laid down in implicit memory, rather than explicit memory that I could readily access, had irrevocably set my brain structure. I wondered, how can I ever be whole if early brain changes are permanent? It’s not that simple, but it has been a relief to learn that important areas of the medial prefrontal cortex can be strengthened; that early impaired caregiver attachment can be repaired; that we don’t need to remain fragmented, we can be whole.
Treatment with a skilled and caring psychotherapist first of all focusses on safety and stability, then on processing traumatic events. Lastly, therapy deals with the split-off alters, accessing those that become available to the conscious self, without dissociating them. ~ The only thing we know that truly works therapeutically is the relationship between the client and the therapist. It took six years of active therapy to fully trust my therapist. That in itself was an enormous achievement, trusting someone to not hurt me, and I would guess it was a major part of my treatment. After that, I was able, painfully, to accept and process the childhood sexual abuse and betrayal trauma that my alternate Parts had protected me from. Finally, we all established communication with each other and reached healing understandings. I’m still working on a few things, like figuring out my relationship to my abuser, but all in all, I am what healing looks like.